Three years since an NAO audit, Mater Dei Hospital has recorded a general decrease in patient waiting-time for elective operations but the hospital still struggles to fill all vacancies for medical consultants

Patient waiting times for elective operations have decreased at Mater Dei Hospital, after the National Audit Office flagged problems inside the hospital’s management system in 2013.

A follow-up audit released last week shows elective operations undertaken at MDH increased from 39,593 in 2013, to 48,252 in 2016, increasing throughput by 22%.

MDH further developed a monitoring system to flag patients who had been waiting for longer than 18 months.

According to the NAO, the hospital addressed inefficiencies by increasing the number of sessions within operating theatres and the number of day surgeries that took place. Indeed, the increase in elective operations included increased operations on Sundays from 639 in 2015 to 1,683 in 2016.

In 2015, the hospital started contracting out operations by outsourcing 161 interventions in public-private partnerships. The hospitals leased fully-equipped operating theatres for use by MDH surgeons. These initiatives led to 448 interventions being performed in private hospitals in 2016.

Intervention throughput also increased through the utilisation of operating theatres at Gozo General Hospital and Mosta Health Centre. In 2016, around 1,519 interventions were carried out at Mosta while 3,996 interventions were performed at Gozo General Hospital.

Long-term patients at MDH were also transferred to proper institutional care systems earlier than usual, also utilising Boffa Hospital to house such patients. Despite the availability of the residential and rehabilitation services, the number of beds occupied by long-term care generally remains the same, at around 80 beds daily.

The NAO’s initial audit in 2013 revealed that although there was a high level of patient satisfaction with Mater Dei services, one-fifth of patients had been waiting for elective operations for over a year.

The audit reported difficulties encouraging consultants and professionals to extend their working hours; an excess of long-term patients at MDH; and the process of computerising the waiting list in a centralised system.

The follow-up audit released this week focused on whether the waiting list management was supported by appropriate policies and strategies.

Although there was an overall progress, some issues were still prevailing, mainly related to daily intervention and logistical arrangements which require better synchronisation of hospital resources.

Despite reviews by senior management, daily intervention lists were still subject to a lot of changes, mainly due to no-shows and clinical priorities.

By the end of 2016, all of the hospital’s departments were using a computerised system for elective surgery waiting lists, a significant improvement over 2013 when only the Orthopaedic and Ophthalmology departments were utilising this system. But the computerised system still required a considerable amount of manual input related to deceased persons, operations undertaken and ‘no-show’ cases. Because of this, some operations were marked as closed one month after the event, rather than a week, as advocated by the Surgical Outpatients Department.

Moreover, four consultants were not making use of the system, going against the principles outlined in the Standard Operating Procedures.

Because of this, Mater Dei’s operating theatres are not yet supported with a fully-functioning electronic system which makes scheduling of patient waiting-times easier.

The NAO also found deviations from procedures on referral of scheduled intervention list: around 40 per cent of the theatre lists were still not received in a timely manner, impacting staffing and other logistical arrangements negatively.

Recruitment at Mater Dei remains a challenge, however, with a number of calls for consultants issued between January 2016 and March 2017. While 85% of the calls were filled, a remaining 15% have not yet been filled.